Severe acne is difficult to treat, but may be manageable. The treatment will focus on preventing future acne outbursts. There are various types of acne treatments; some target the surface of the skin, while others will be systemic. The type of treatment will be established according to the severity of the acne. Milder forms of acne can be treated with over the counter products, while severe acne will require the assistance of a dermatologist.

1. Topical Products for Acne

Topical products are recommended for patients that have acne, regardless of the severity. There are several options of topical creams, which can vary in strength and may include: 

  • Salicylic acid creams
  • Nenzoyl peroxide
  • Sulfur creams
  • Retinoids and vitamin A derivates, such as tretinoin or adapalene
  • Topical antibiotic creams, such as erythromycin

2. Systemic Acne Treatment

The systemic acne treatment may include drugs or injections that will work from the inside out, reducing the acne and preventing future outbursts. The systemic treatments may be used in conjunction with the topical treatments and may include:

  • Antibiotics, such as erythromycin or doxycycline
  • Birth control pills, applied if the patient has a hormonal imbalance
  • Isotretinoin also known as accutane, which is a vitamin A derivate

3. Comedo Extractions

Comedo extractions may be recommended, but should be performed by a dermatologist or an esthetician. Performed at home, this may result in the infection of the skin, due to the possible bacteria present under the nails.

The extraction will be performed with local anesthesia or with no anesthesia at all. The dermatologist will make sure to extract only commedones and blackheads, as cysts may only be removed through surgery.

4. Chemical Peels

Chemical peels can be performed by dermatologists, plastic surgeons or estheticians and will focus on removing the dead skin cells, exfoliating the skin cells. The substances used in chemical peels include:

  • Alpha hydroxy acids
  • Beta hydroxy acids
  • Glycolic acids

5. Microdermabrasion

Microdermabrasion is a cosmetic treatment that employs a machine. The machine will work on removing dead skin cells, debris and unclog the pores, so that the acne will be less likely to occur. This type of treatment is recommended for patients that have whiteheads or blackheads.

6. Laser Treatments

There are several laser treatments that use laser or light to treat severe acne. This type of treatment is also known as phototherapy. The laser beams will reduce inflammation and clear the skin. There are several types of light that can be used and various intensities, which can be adapted according to the severity of the acne.

The laser and light treatments cannot be applied in patients that take oral retinoids or use topical ointments that contain vitamin A derivates. The treatment with retinoids should be discontinued for at least 6 months before the lasers can be used, so that complications can be avoided.

7. Corticosteroid Injections

Corticosteroids are recommended for cysts and inflamed acne. The injections will reduce the inflammation, promote the healing and will prevent the formation of scars.